If you are applying by the OPM Form 1203-FX, leave this section blank.

7. Background Information

If you are applying by the OPM Form 1203-FX, leave this section blank.

8. Other Information

If you are applying by the OPM Form 1203-FX, leave this section blank.

9. Languages

If you are applying by the OPM Form 1203-FX, leave this section blank.

10. Lowest Grade

00

11. Miscellaneous Information

If you are applying by the OPM Form 1203-FX, leave this section blank.

12. Special Knowledge

If you are applying by the OPM Form 1203-FX, leave this section blank.

13. Test Location

If you are applying by the OPM Form 1203-FX, leave this section blank.

14. Veteran Preference Claim

15. Dates of Active Duty - Military Service

16. Availability Date

17. Service Computation Date

18. Other Date Information

If you are applying by the OPM Form 1203-FX, leave this section blank.

19. Job Preference

If you are applying by the OPM Form 1203-FX, leave this section blank.

20. Occupational Specialties

001 Psychologist

21. Geographic Availability

205400177 Topeka, KS

22. Transition Assistance Plan

23. Job Related Experience

If you are applying by the OPM Form 1203-FX, leave this section blank.

24. Personal Background Information

If you are applying by the OPM Form 1203-FX, leave this section blank.

25. Occupational/Assessment Questions:

ELIGIBILITY: The following section is used to determine your eligibility for appointment in the Federal Government. FAILURE TO RESPOND TO THESE QUESTIONS MAY RESULT IN AN INELIGIBLE RATING. Please choose A ( Yes ) or B ( No ) for each of the following items to identify which of the following descriptions applies to you.

For each task in the following group, choose response below that best describes your experience and/or training. Darken the oval corresponding to that statement in Section 25 of the Qualifications and Availability Form C. Please select only one letter for each item.

A- Yes.B- No.

1. I am a Citizen of the United States.

2. I have earned a doctoral degree in Psychology from an accredited college or university whose graduate curriculum is approved by the American Psychological Association (APA). The specialty area is consistent with the assignment for which I would be employed.

3. I have successfully completed a professional psychology internship training program that has been accredited by the APA.

A. Yes.B. No.

The following questions pertain to your licensure and/or certification. Note: The Psychologist must hold a full, current, and unrestricted license to practice psychology at the doctoral level in a State, Territory, Commonwealth of the United States, or the District of Columbia.

For each task in the following group, choose response below that best describes your experience and/or training. Darken the oval corresponding to that statement in Section 25 of the Qualifications and Availability Form C. Please select only one letter for each item.

A- Yes.B- No.

4. I hold a full, current, and unrestricted license to practice psychology at the doctoral level in a State, Territory, Commonwealth of the United States (e.g., Puerto Rico), or the District of Columbia.

Licensure requirement may be waived by the Secretary of the Department of Veterans Affairs for a period not to exceed two (2) years from the date of employment on the condition that the psychologist provide care only under the supervision of a licensed psychologist.

5. I am a non-licensed psychologist and meet the eligibility requirements as stated above

A. YesB. No

For each task in the following group, choose response below that best describes your experience and/or training. Darken the oval corresponding to that statement in Section 25 of the Qualifications and Availability Form C. Please select only one letter for each item.

A- Yes.B- No.

6. I am proficient in spoken and written English.

7. Veterans Preference - Veterans who served on Active Duty in the U.S. Armed Forces and were separated under Honorable conditions may be eligible for Veterans' Preference.

For service after October 15, 1976, the Veterans must have received a Campaign Badge, Expeditionary Medal, a service connected disability, or have served during the Gulf War Between August 2, 1990 and January 2, 1992 or for more than 180 consecutive days, other than training, any part of which occurred during the period beginning September 11, 2001, and ending on the date prescribed by Presidential proclamation or by law as the last day of Operation Iraqi Freedom.

To claim Veterans' Preference, Veterans should be ready to provide a copy of their DD-214, Certificate of Release (that reflects the nature of your Honorable discharge) or discharge from Active Duty, or other proof. Veterans with service connected disability and others claiming "10 point preference" will need to submit form SF-15, Application for 10-point Veterans' Preference.

Please choose the ONE statement below that applies to you.

A. I am eligible for tentative ("5-point") preference.B. I am eligible for "10-point" preference as a 30% or mroe compensably disabled Veteran.C. I am eligible for "10-point" preference as a compensably disabled Veteran (less than 30%).D. I am eligible for widow or spouse preference.E. I am not eligible for Veterans preference.

8. Your rating is subject to verification based on the resume, narratives, and other relevant documents you submit, and through verification of references as appropriate. Deliberate attempts to falsify information are grounds for non-selection and for termination. In addition, falsifying information on your application can result in you being barred from federal employment. Please choose A to certify that your answers are accurate and complete.